Antibiotics and Myasthenia Gravis As infection can cause a myasthenic exacerbation or crisis, it should be treated swiftly while taking care to avoid additional patient harm.
Continue Reading. Please login or register first to view this content. A recent retrospective study evaluated the association of myasthenia gravis with low-osmolality contrast agents. The median time to symptoms was 11 days. The authors concluded that other causes of the myasthenia gravis exacerbations were more likely than the contrast agents, but patients with myasthenia gravis receiving contrast should be monitored carefully.
Glucocorticoids, although a mainstay in the management of moderate to severe myasthenia gravis, can also cause muscle weakness. In one study, independent predictors of exacerbation caused by steroids included older age, bulbar symptoms, and severe neurologic presentation, especially in the initial phase of treatment. Proposed mechanisms include release of antibodies from degraded lymphocytes, increased cholinesterase activity in the neuromuscular junction, and increased immune-related reactions.
A number of reports are available associating immune checkpoint inhibitors such as avelumab, ipilimumab, pembrolizumab, tremelimumab, nivolumab, sintilimab, and atezolizumab with myasthenia gravis. The pathophysiology remains unknown, but generally signs and symptoms begin within 2 to 6 weeks of treatment with these agents. In some patients, prior myasthenia has been exacerbated by immune checkpoint inhibitors, and in other patients myasthenia gravis occurs for the first time after initiation of an immune checkpoint inhibitor.
Patients without severe symptoms may have a second trial of medication. While penicillamine is very well-documented to be a cause of myasthenia gravis, there are no reports of exacerbation in a patient already diagnosed with myasthenia gravis. Although statins are known to cause myotoxicities, myasthenia gravis exacerbations have not been well-reported in the literature. There was variability in the timing of the presentation and resolution of the symptoms relative to statin therapy.
Some authors suggest these symptoms could be due to several potential mechanisms, including underlying myasthenia gravis aggravated by the muscle toxicity of statins or antibody-mediated myasthenia gravis induced by statins.
Published Accessed June 19, Fluoroquinolone associated myasthenia gravis exacerbation: clinical analysis of 9 cases [in Chinese]. Zhonghua Yi Xue Za Zhi.
Possible exacerbation of myasthenia gravis by ciprofloxacin. Mumford CJ, Ginsberg L. Ciprofloxacin and myasthenia gravis. Exacerbation of myasthenia gravis by perfloxacin [in French].
Rev Neurol Paris. Exacerbation of myasthenia gravis by norfloxacin. Probable exacerbation of myasthenia gravis by ofloxacin. J Neurol. Fluoroquinolone-associated myasthenia gravis exacerbation: evaluation of postmarketing reports from the US FDA adverse event reporting system and a literature review. Drug Saf. Herishanu Y, Taustein I. The electromyographic changes induced by antibiotics: a preliminary study.
Confin Neurol. Exacerbation of pseudoparalytic myasthenia gravis following azithromycin Zithromax [in German]. Schweiz Med Wochenschr. Additionally, 3. Five patients experienced a worsening of their myasthenia gravis symptoms with antibiotic use; 2 cases involved levofloxacin and 1 case each involved ciprofloxacin, cefazolin, or clindamycin. Of note, the average duration of therapy prior to symptoms being noted was 2.
This study highlights the wide variation in antimicrobial prescribing for patients with myasthenia gravis. Our chart review identified few adverse reactions exacerbating disease symptoms related to antimicrobial use. As it is still unclear the exact mechanism for the development of reactions in select patients with myasthenia gravis, further research may be needed to elucidate this information.
Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume 4. Article Contents Abstract.
0コメント